| NPI | 1952800781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006656) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95006656) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: CA 95006656) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95006656) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95006656) | |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2019-12-09 |